A Single-Visit Solution by Dr. Nadim Z. Baba

Digital dentures in a few hours offer a safer option for a patient who can’t risk visiting the practice several times

by Dr. Nadim Z. Baba

Seniors living in long-term assisted-living care facilities and nursing homes are a particularly vulnerable population when it comes to receiving proper oral care.¹ The aging population in the United States is living longer² and retaining more of their natural teeth than previous generations.³ As these seniors transition from independent to dependent living, their oral needs often go unaddressed, resulting in tooth loss, poor oral hygiene and oral disease.⁴ Good oral health significantly affects general health, especially in older adults, because the ability to chew and consume food affects the quality of their diet and, as a consequence, their overall health. The oral health of residents in long-term care facilities is often not perceived as a priority by caretakers, which delays assessment and treatment.⁴

In recent years, the ability to properly treat geriatric adults has been exacerbated by the pandemic, because this older population is more susceptible to infection and compromised by existing age-associated health conditions.⁵ For this most vulnerable patient demographic, treatments that require multiple appointments and long appointment times increase the risk of COVID-19 infection for both the patient and the dental care professional. Treatment options that limit the number of in-practice visits are optimal for treating these patients.


Clinical report

A 94-year-old patient who lives in a long-term assisted-living facility with his wife was referred to the practice by his daughter, a longtime patient of the dental practice. The chief complaint was that he had difficulty eating because of the degradation of his teeth. The daughter requested her father be fitted with dentures to restore his chewing ability, aesthetics and self-esteem, but she also wanted a solution that did not require multiple practice visits, because taking him from the assisted-living facility was a difficult process and increased his chances of exposure to the coronavirus.

Because of the patient’s age and vulnerability if exposed to COVID-19, he was scheduled for a Saturday appointment, when no other patients or staff would be present. Upon initial examination, it was obvious he had been mostly edentulous for many years: The mandibular arch was edentulous and only four tooth roots remained in the maxillary arch (Fig. 1). The treatment plan that would best fit this patient with a long-term and aesthetic solution without multiple visits to the practice was an immediate CAD/CAM-milled monolithic denture.

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• The ability to efficiently and effectively treat patients who have difficulty commuting to the practice for multiple appointments.
• The ability to record clinical information (impressions, interocclusal records, and tooth selection) in a single, one- to two-hour appointment, depending on the clinician’s experience.
• The ability to place and seat the dentures in the second appointment.
• The ability to reduce clinical chair time, which is more cost effective and decreases practice overhead.
• The ability to archive digitally obtained 3D images and record-taking data in the event the patient should need a replacement denture.
• And the prepolymerized acrylic resin used for the fabrication of the denture base provides a superior fit and strength compared with conventionally processed bases.

References
1. Porter, J., Ntouva, A., Read, A., Murdoch, M., Ola, D., and Tsakos, G. “The Impact of Oral Health on the Quality of Life of Nursing Home Residents.” Health Qual Life Outcomes. 2015;13:102.
2. Medina, Lauren, Sabo, Shannon, and Vespa, Jonathan. “Living Longer: Historical and Projected Life Expectancy in the United States, 1960 to 2060 Population Estimates and Projections.” U.S. Census Bureau, US Department of Commerce. https://www.census.gov/library/publications/2020/ demo/p25-1145.html, accessed Feb. 7, 2022.
3. CDC. Public Health and Aging: Retention of Natural Teeth Among Older Adults—United States, 2002. https://www. cdc.gov/mmwr/preview/mmwrhtml/mm5250a3.htm, accessed Feb. 7, 2022
4. Badewy, Rana, Singh,Kharkirat, Quinone, Carlos, and Singhal, Sonica. “Impact of Poor Oral Health on Community- Dwelling Seniors: A Scoping Review.” Health Service Insights, Vol. 14: 1–19. Accessed Feb. 7, 2022.
5. CDC. COVID-19 Risks and Vaccine Information for Older Adults. www.cdc.gov. Accessed Feb. 7, 2022.
6. Smith, P.B., Perry, J., and Elza, W. “Economic and Clinical Impact of Digitally Produced Dentures.” J Prosthodont 2021;30(S2):108–112.
7. Janeva, N.M., Kovacevska, G., Elencevski, S., Panchevska, S., Mijoska, A., and Lazarevska, B. “Advantages of CAD/ CAM Versus Conventional Complete Dentures—A Review.” Open Access Maced J Med Sci. 2018 Aug 4;6(8):1498–1502.
8. Baba, N.Z., Goodacre, B.J., Goodacre, C.J., Müller, F., and Wagner, S. “CAD/CAM Complete Denture Systems and Physical Properties: A Review of the Literature.” J Prosthodont 2021;30(S2):113-–124.